Provider Demographics
NPI:1942065743
Name:CHOSEN ONE - TDC
Entity type:Organization
Organization Name:CHOSEN ONE - TDC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICE FACILITATOR
Authorized Official - Prefix:
Authorized Official - First Name:TYQUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHURCHWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-517-4411
Mailing Address - Street 1:10502 MARIONS WAY
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-4009
Mailing Address - Country:US
Mailing Address - Phone:804-517-4411
Mailing Address - Fax:804-261-2186
Practice Address - Street 1:10502 MARIONS WAY
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-4009
Practice Address - Country:US
Practice Address - Phone:804-517-4411
Practice Address - Fax:804-261-2186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management